Provider Demographics
NPI:1770286296
Name:ROSS, CLINT
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14038 CHINA SPRING RD # 13
Mailing Address - Street 2:
Mailing Address - City:CHINA SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:76633-3450
Mailing Address - Country:US
Mailing Address - Phone:512-334-6449
Mailing Address - Fax:512-212-7470
Practice Address - Street 1:14038 CHINA SPRING RD # 13
Practice Address - Street 2:
Practice Address - City:CHINA SPRING
Practice Address - State:TX
Practice Address - Zip Code:76633-3450
Practice Address - Country:US
Practice Address - Phone:512-334-6449
Practice Address - Fax:512-212-7470
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional